HEDIS for Tufts Health Public Plans

Healthcare Effectiveness Data and Information Set (HEDIS)

HEDIS is a set of standardized performance measures the National Committee for Quality Assurance (NCQA) developed to allow for comparison across health plans based on quality.

Your HEDIS scores can also help you understand how you compare to other Tufts Health Public Plans providers, as well as to the national average. By working together, we can ensure your Tufts Health Public Plans patients, our members, receive optimal preventive and quality care.

Below is a list of measures the health plan collects via medical record review. The HEDIS measures we collect may change annually. The remainders of the measures are collected using claims data.  Please call us at 888.257.1985 if you have questions or want more information about other HEDIS measures.

Tufts Health Public Plans' HEDIS 2018 (CY2017) Measures

Preventive Health Care

Frequency of ongoing prenatal care prenatal care
Received at least 81% of expected prenatal visits

Timeliness of Prenatal Care
Received a prenatal care visit during first trimester or within 42 days of Tufts Health Public Plans enrollment

Timeliness of Postpartum Care
Received a postpartum visit within 21–56 days after delivery

Childhood immunizations Age: Children 2 years old
Received the following immunizations by the second birthday:

  • One chicken pox (VZV)
  • One measles, mumps and rubella (MMR)
  • One hepatitis A (Hep A)
  • Two influenza (flu) vaccines
  • Two or three rotavirus (RV)
  • Three Haemophilus influenza type B (HiB) (HiB)
  • Three Hepatitis B (Hep B)
  • Three polio (IPV)
  • Four diptheria, tetanus and acellular pertussis (DTaP)
  • Four pneumococcal conjugate (PCV)

Lead Screening in Children Age: Children 2 years old
Received one or more capillary or venous lead blood tests for lead poisoning by the second birthday

Well-Child Visits Age: 15 months old
Received at least six well-child visits with PCP within first 15 months of life

Well-Child Visits Ages: 3 – 6 years old
Received one or more annual well-child visits with PCP

Adolescent Well Visits Ages: 12 – 21 years old
Received at least one annual comprehensive well visit with a PCP or OB/GYN

Adolescent Immunizations Age: Adolescents 9–13 years old
Received the following immunizations by 13th birthday:

  • One meningococcal conjugate vaccine
  • One tetanus, diptheria toxoids and acellular pertussis (Tdap) vaccine
  • At least two or three HPV vaccines with different dates of service

Cervical Cancer Screening(s) Ages: Women 21 – 64 years old
Received one or more Pap test every three years

Cervical Cancer Screening(s) Ages: Women 30 – 64 years old
Received one or more Pap with an HPV co-test every five years

Care for older adults Ages: Adults 66 years and older
Received each of the following during the measurement year:

  • Advance care planning
  • Medication review
  • Functional status assessment
  • Pain assessment

Weight Counseling for Nutrition and Physical Activity Ages: 3 – 17 years old
Received an outpatient visit with a PCP or OB/GYN and had evidence of the following during the measurement year:

  • Body mass index (BMI) percentile documented
  • Counseling for nutrition
  • Counseling for physical activity

Adult BMI Assessment Ages: 18 – 74 years old
Received an outpatient visit and had a BMI or BMI percentile (for members younger than 20 years of age) documented during the measurement year or the year prior to the measurement year

Colorectal Cancer Screening Ages: 50 – 75 years old
Received one or more following screenings for colorectal cancer:

  • Fecal occult blood test during the measurement year
  • Flexible sigmoidoscopy during the measurement year or the four years prior to the measurement year
  • Colonoscopy during the measurement year or the nine years prior to the measurement year
  • CT colonography during the measurement year or the four years prior to the measurement year
  • FIT-DNA test during the measurement year or the two years prior to the measurement year

Condition-Specific Care

Comprehensive Diabetes Care Ages: 18 – 75 years old
Has a diagnosis of Type 1 or Type 2 diabetes and has received each of the following during the measurement year:

  • HbA1c testing and results1
  • Dilated or retinal eye exam by an eye care professional in the measurement year; or a negative retinal exam confirmed by eye care professional in the year prior to the measurement year; or bilateral eye enucleation anytime during the member’s history through December 31 of the measurement year
  • Nephropathy screening or monitoring test or evidence of nephropathy
  • Blood pressure (BP) control <140/90 mm Hg1

Controlling High Blood Pressure (BP) Ages: 18 – 85 years old
Received hypertension (HTN) diagnosis by June 30 of the measurement year, and whose BP was adequately controlled after the diagnosis of hypertension based on the following criteria2:

  • Members 18-59 years of age whose BP was <140/90 mm Hg
  • Members 60-85 years of age who were flagged with a diagnosis of diabetes and whose BP was <140/90 mm Hg
  • Members 60-85 years of age who were flagged as not having a diagnosis of diabetes and whose BP was <150/90 mm Hg

Medication Management

Medication Reconciliation Post-Discharge Ages: Adults 18 years and older
Discharged between January 1 and December 1 during the measurement year and reconciled medications within 30 days of discharge

Please note: Measurement year is January 1, 2017, to December 31, 2017, unless otherwise indicated.

  1. Must report most recent results for the measurement year.
  2. Must report most recent values.